PIE Credit Union APPLICATION FOR CLOSED-END CREDIT TEL ...

PIE Credit Union

APPLICATION FOR CLOSED-END CREDIT TEL: 713/551-0491 ? FAX 713/551-0431

Amount Requested

First Payment Due Date

Payment Frequency

Purpose of Loan

Collateral (Secured Loan)

INFORMATION REGARDING APPLICANT

Full Name

Birth Date

Present Address

Years There

City

State

Zip Code

Home Phone

Cell Phone

Social Security No

Drivers License No.

Previous Address

Years There

City

State

Zip Code

Present Employer

Years There

Employer's Address

City

State

Zip Code

Position/Title

Business Phone

Supervisor

Previous Employer

Address

Years There

Number of Dependents (excluding self)

Ages

Name of nearest relative not living with you

Relationship

Address

Phone No.

Personal Reference Name

Full Address

Phone No.

Salary o Gross o Net $

Per

Other Income

Per

Source

*Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this loan

Is any income listed likely to be reduced within the next two years? o No o Yes

If yes, explain

Share Draft or Checking Account No.

Where

Share or Savings Account No.

Where

INFORMATION REGARDING JOINT APPLICANT, USER OR OTHER PARTY? (Use separate sheet if necessary)

Full Name

Birth Date

Relationship to Applicant (if any)

Present Address

Years There

City

State

Zip Code

Home Phone

Cell Phone

Social Security No.

Drivers License No.

Previous Address

Years There

City

State

Zip Code

Present Employer

Years There

Employer's Address

City

State

Zip Code

Position/Title

Business Phone

Supervisor

Previous Employer

Address

Years There

Number of Dependents (excluding self)

Ages

Name of nearest relative not living with you

Relationship

Address

Phone No.

Personal Reference Name

Full Address

Phone No.

Salary o Gross o Net $

Per

Other Income

Per

Source

*Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this loan

Is any income listed likely to be reduced within the next two years? o No o Yes

If yes, explain

Share Draft or Checking Account No.

Where

Share or Savings Account No.

Where

COMPLETE PAGE 2

MARITAL STATUS: Check applicable box(es) below if this loan is for:

A. Joint or secured credit or B. You reside in or rely on property located in a Community Property State (AZ, CA, ID, LA, NM, NV, TX, WA, WIS)

Applicant:

J Unmarried

J Married

J Separated

Other party:

J Unmarried

J Married

J Separated

OUTSTANDING DEBTS (Use separate sheet if necessary. Include information about any Joint Applicant, User or Other Party. Please check the "A` box to indicate Applicant or Joint Applicant information.

Creditor

Type of Debt or Account #

J Rent J Mortgage

Name(s) in Which Account is Carried

ORIG. DEBT

PRESENT BALANCE

MONTHLY PAYMENT

PASTDUE YES/NO

"A"

TOTALS

Are there any unsatisfied judgements against applicant and/or other party?

J Yes J No

If yes, by whom?

To whom?

Amount $

Are there any other persons obligated on any of the above loans? J Yes J No

Which ones?

Who?

Is applicant and/or other party a comaker, cosigner or guarantor on any loan? J Yes J No

For whom?

To whom?

Has the applicant and/or other party been the subject of an order for relief under The Federal Bankruptcy Code or adjudicated a bankrupt under the Bankruptcy Act in the last 10 years? J Yes J No

Everything that I/we have stated in this application is correct to the best of my/our knowledge. You are authorized to check my/our credit and employment history and to answer questions about your credit experience with me/us.

Signature of Applicant X

Date

Signature of Other Party (where applicable) X

Date

Account No.

Loan Balance(s)

Loan Officer:

J Approved

J Rejected/Referred to C.C.

FOR CREDIT UNION USE ONLY Note No. Loan Status

Reason

L.O. signature

Credit Committee

Date

J Approved

J Rejected

Reason for rejection

Outside information considered Conditions, if any:

J No J Yes (Describe)

Signed

Signed

Signed

Share Balance(s)

Date

Date Date Date

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download